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71 Cards in this Set
- Front
- Back
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What is the management of infants of Hep B + mothers?
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. Give HBIG (HepBimmunoglobulins) and the 1st 3 doses of the vaccine at birth
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What is Primary Biliary Cirrhosis?
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. Female middle-aged
. Fatigue, pruritus . Increased Alk. Phos . + antimitochondrial antibodies . Tx: ursodeoxycholic acid and cholestyramine |
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Which medication can be taken as prophylaxis to prevent bleeding in esophageal varices?
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. Nadolol
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What is the risk of contracting Hep B during transfusions?
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. 1 in 200.000
. much higher than Hep C |
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What are the drugs of choice for SBP?
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. cefotaxime and ceftriaxone
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Pruritic vesicles, papules, wheals on the extensor aspects of the elbows and knees, maybe face and neck + diarrhea and weigh loss, should make you think of what condition?
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. Dermatitis Herpetiformis
. Gluten sensitivity . Stop gluten |
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Which hepatitis is more sexually transmitted , B or C?
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. B. C is rarely if ever sexually transmitted.
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What does a BP of 94/60 represent?
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. Any systolic value under 100=>30% blood loss
. any pulse >100 is the same |
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What is Charcot triad?
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. Fever
. RUQ pain . Jaundice . Diagnostic of acute cholangitis = gallstone impacted in the common bile duct . TX: cholecystectomy |
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What is the MC presentation of a liver adenoma?
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. Rupture into the peritoneal cavity with consequent hemiperitoneum and shock
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When is liver biopsy recommended with hemochromatosis?
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. whenever Ferritin levels are >1000 mg/mL
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What is the treatment for ischemic colitis?
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. bowel rest with continued observation for deterioration and broad-spectrum abx
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What are some drugs responsible for drug induced hepatitis?
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. acetaminophen
. INH . halothane . CCl4 . tetracycline |
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How does acute cholecystitis manifests and what causes it?
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. Biliary colic + pain in right hypochondrium that radiates to the right shoulder
. small gallstone impacted in the cystic duct |
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Which gastci tumor has a better prognosis, pyloric antrum or proximal 2 1/3rds of the stomach?
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. Pyloric antrum has a better outcome
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. What is the rate of transmission in Hep B kids of infected mothers?
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. Only 2.5% of infants are positive at birth
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What is pernicious anemia?
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. gastric atrophy
. megaloblastic anemia . vitamin B12 deficiency . antibodies to parietal cells . antibodies to intrinsic factor . decreased acid secretion |
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What is the classic description of adenocarcinoma?
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. Mucin-producing glandular tissue with signet ring cells
. due to barret or long standing GERD |
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How does hemochromatosis presents?
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. AR
. excessive iron absorption . DM . Dilated cardiomyopathy . skin pigmentation (bronze DM) . arthritis |
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What procedure would be most likely to confirm a diagnosis of diverticulitis?
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. Abdominal CT scan
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what's the serology for HBV?
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. needles, sex, perinatal
. HBsAg + = unresolved infection (acute or chronic) . HBeAg = increased infectivity . HBeAb = decreased infectivity . IgM anti HBc - window . HBsAb = immune |
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What do you do in high-grade dysplasia of Barret's?
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. Esophagectomy
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How do you diagnose mesenteric ischemia?
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. CT
. MRI . Angiogram |
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When the serum ascites albumin gradient is >1.1 what does that represent?
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. portal HTN as from cirrhosis
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Which Hepatitis is most commonly transmitted sexually in the USA?
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. Hep B and D
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What are the 3 MCC of fatty liver?
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. alcohol
. obesity . DM |
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How do you tx toxic megacolon?
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. NPO
. NG tube + IV fluids . ampicillin or cefazollin ( to cover bowel flora) . steroids if the cause if IBD |
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Compare Crohn's to UC
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. CROHNS - Distal ileum, colon
- transmural - skip-lesions - mouth to anus - obstruction, abd pain - fistulas, cobblestoning, string-sign on xray - cancer risk slightly increased - UC - Rectum - mucosa and submucosa only - continuous, no skipped lesions - colon + rectum - bloody diarrhea - pseudopolyps, toxic megacolon - markedly increased |
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How do you tx C. difficile?
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. metronidazole or
. vancomycin |
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Hep C will develop to chronic hep C in what % and what is the tx?
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. in 80-90% of cases
. tx with ribavarin and alpha-interferon |
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what medication decreases portal HTN pressures and therefore decreases the risk of bleeding from esophageal varices?
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. Nadolol
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How do you diagnose Wilson's disease?
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. Decreased serum ceruloplasmin
. Increased urinary copper . Decreased serum copper . Liver biopsy confirms diagnosis showing excessive copper . Tx: penicillamine |
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What's the presentation of pheochromocytoma?
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. Headaches
. Palpitations . Perspiration . Pallor . Increased BP . Diagnose with increased VMA |
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What is the risk of contracting Hep C during transfusions?
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. 1 in 1.900.000
. way lower than Hep B |
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How do you diagnose diverticulosis?
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. colonoscopy
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What dermatitis is associated with celiac sprue?
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. Dermatitis Herpetiformis
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What is acute cholangitis secondary to?
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. Usually to gallstones in the common bile duct
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What vascular disease if Hep B associated with?
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. PAN
. Spotty distribution . Pea shaped nodules along the superficial leg arteries |
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What's the common presentation of a pt with hemochromatosis?
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. Asymptomatic
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How do you confirm the diagnosis of UC?
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. sigmoidoscopy
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What's the serology for Hep A?
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. + IgM Ab to Hep A during jaundice or shortly after
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What is kernicterus due to and where it's deposited?
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. due to increased levels of unconjugated bilirubin
. deposits in the basal ganglia |
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What are the findings in achalasia?
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. HTN LES
. Loss or bad peristalsis . no heartburn . barium swallow reveals dilated esophagus with bird-beak narrowing . tx with balloon dilation or CCBs |
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What are some extraintestinal manifestations of UC?
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. Peripheral arthritis
. pyoderma gangrenosum . epicleritis, conjunctivitis . erythema nodosum |
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What are some clues to esophageal CA?
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. alcohol + smoking
. proximal 2/3 = squamous cell CA . distal 1/3 = adenocarcinoma due to GERD or Barrett's . progressive dysphagia, first solids, then liquids . endoscopy for diagnosis . tx with durgical resection |
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what's ascending cholangitis?
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. pain + fever
. Bacteria gaining ascess to the biliary system during acute cholangitis |
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Post-transfusion hep is most often due to infection with what?
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. Hep C
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is breastfeeding contraindicated in Hep B + mothers?
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. No
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What's the serology for HCV?
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. IV needles, rarely sex
. HCVAb = exposure but not immunity . HCV RNA = infection status |
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How do you suspect bile duct obstruction?
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. Increased alk phos
. Increased conjugated bilirubin > unconjugated . pruritus . clay-colored stools . dark urine strongly bilirubin + |
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How do you tx hyperammonemia?
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. Decrease protein intake
. Lactulose (prevents NH3 absorption) . Neomycin (stops bowel flora from making NH3) |
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How does Wilson's disease presents?
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. CNS or psychiatric manifestations (copper deposits in basal ganglia and lentiform nucleus)
. Kayser-Fleischer rings in eyes |
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What's the tx for ascitis?
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. H2O + Na restriction
. Spironolactone . Thiazides - when spironolactone doesnt work . Frequent abdominal paracentesis |
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What is orthostatic hypotension and what does it represent?
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. it's a >10 point rise in pulse from supine to sitting
. or >20 point drop in systolic from changing positions . means 15 to 20% blood loss |
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What Ab will be positive on Hep B immunizations?
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. Surface Ab, not core
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Which gastric condition is associated with gastric ca?
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. Pernicious anemia
. Chronic atrophic gastritis |
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Which complication of UC is reversible once complete removal of the colon is done?
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. Pyoderma gangrenosum
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What do you expect to see with head traumas or burns?
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. Acute erosive gastritis
. Also called stress gastritis |
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What hallucinations is associated with alcohol withdrawal?
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. Visual or tactile hallucinations
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How do you suspect the diagnosis of hemochromatosis?
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. AR
. increased serum iton . increased transferrin saturation . increased ferritin levels . confirm with DNA testing (282Y gene) . tx with phlebotomy |
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What medications is given IV as TX for acute GI bleeding due to esophageal varices?
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. octreotide
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What vitamin is deficient on carcinoid syndromes and why?
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. Niacin
. Because increased production of serotonin produces a tryptophan deficiency (both serotonin and niacin are produced from tryptophan) which leads to a deficiency of niacin . Causes pellagra 3 D's: diarrhea, dementia, dermatitis |
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What's the clinical presentation of ischemic cholitis?
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. 6th-8th decades of life
. x-ray with thumb printing - mucosal edema with associated hematoma formation . gas in the wall of the colon (pneumotosis coli) |
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How do you diagnose diverticulitis?
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. CT
. colonoscopy not indicated during acute phase of diverticulitis (it can perforate) |
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Which polyp carries no increase in malignancy potential and which ones do?
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. Hyperplastic polyps carry no increase
. tubular adenoma, the least . villous adenoma, the most |
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What's the histologic changes in Barrets?
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. Metaplastic change in the epithelium from squamous to columnar
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When the serum ascites albumin gradient ( SAAG) is <1.1. what does that represent?
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. ascitic fluid albumin level is high such as in CA, TB, pancreatitis
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What's the tx for achalasia if dilation and botulism toxin fails?
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. myotomy of the esophagus distally (laparoscoppically)
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Urticaria is associated with up to 25% of what disease?
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. acute hepatitis B
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Severe pain that is significantly better when the pt lies quietly should specifically suggest what condition?
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. Peritonitis
. also guarding . localized or diffuse tenderness . absent peristalsis (severe cases) |
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What's the presentation of carcinoid syndrome?
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. Flushing
. diarrhea . wheezing . confirm with 5-HIAA |
